How to explain the surprisingly strong Obamacare signups

Open enrollment is here and lasts until mid-December. Initial signups have been strong. (Associated Press)

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Open enrollment for Obamacare began on Nov. 1, and more than 601,462 people signed up in the first four days. That’s considered a strong number — it’s up 179% compared to the same period last year, according to former Health and Human Services official Andy Slavitt.

BREAKING: ACA open enrollment sign-ups up 179% compared to the equivalent period last year.

2017 has been a wild year for the Affordable Care Act, known as Obamacare. The law survived multiple attempts at repeal from the Republican-held Congress, making the strong initial showing and full coverage in every county with at least one insurer surprising to some.

Confusion and Streisand effect

The political turmoil has been a double-edged sword. On the one hand, it’s contributed to an overwhelming sense of confusion for consumers.

“Our own polling found that people were really confused heading into open enrollment,” said former HHS official Lori Lodes, who ran HealthCare.gov’s marketing and now promotes enrollment. “There were a lot of people that thought it had been repealed.”

Nonstop coverage in the media on the law’s assault — including the premium increases — has led some consumers to simply assume health care would be unobtainable.

But on the other hand, a curious Streisand effect may take some credit for the initial success, though as Lodes notes, it’s too early to tell. The Streisand effect is when someone tries to hide or suppress something and accidentally creates publicity through those efforts. (For Barbra Streisand, it was trying to suppress photos of her mansion.)

“There’s no doubt there’s been some Streisand effect (at least from everything we’re seeing),” said Jamil Poonja, senior growth strategy manager at Stride Health, a company that enrolls many gig-economy workers on the public exchanges. “We’re seeing nearly double the number of people shopping for coverage.”

Reached for comment, a Center for Medicare and Medicaid Services spokesperson noted the website “performed optimally” during the first week of open enrollment. “People went to the website to address anxiety just because there has been so much attention to this,” Lodes said.

The demand may have a simple explanation: people like healthcare

According to Stride Health’s CEO Noah Lang, people have not quit the Affordable Care Act exchanges because of one simple fact: they need healthcare.

“It comes back to the resilience of the demand,” Lang said. “Whether you think of it as a human right or a human need, it’s necessary — especially for the population we serve.”

Even though there’s confusion and some widespread belief that premiums will be unaffordable, people are at least checking the exchanges. For patients receiving subsidies, which is 80% of the Obamacare participants, lower-cost bronze plans are inexpensive and even free for older people.

According to the Kaiser Family Foundation, 54% of uninsured people could get a plan for less than the mandate penalty would cost.

“People went thinking, ‘I guess I can’t afford it.’ What they figured out was that healthcare was more affordable that they thought,” Lodes said.

Some of this can be attributed to the growing familiarity with the marketplaces. After half a decade of the Affordable Care Act, there is growing literacy around enrollment.

“There is just a heightening understanding of ACA marketplace,” Lodes said. “People are more aware.”

“I’d also attribute it to the fact that five years in, people have a firmer understanding for the process, have resources to navigate the marketplaces, and know how much they need coverage,” said Poonja.

Poonja also cited a Stride survey that found just 9% of self-employed individuals who are currently uninsured plan to stay uninsured for 2018. Looking at CMS data, it’s clear that the uninsured are interested in becoming insured.

“We expected for people returning there would be an increase there because of the heightened anxiety,” Lodes said. “It was pleasantly surprising how many new people came into the marketplace.”

However, Lodes is still concerned about cuts to advertising made by the Department of Health and Human Services under the Trump administration. At the beginning of the year, the Trump administration canceled some already paid-for advertising and slashed the advertising budget. This hurts young people, Lodes said, who often need many reminders to get them to participate.

“They’re probably not aware it’s happening right now unless there’s a relentless reminder that open enrollment is here and you have to take action by December 15,” she said. “Unless that message [is] getting through multiple times in multiple ways we’re leaving a lot on the table.”